This practice covers certified, tested, commercial type, EMSS ambulances built on chassis that are suitable for the intended application and meet the requirements herein, it also covers the design, construction, and procurement of emergency medical services systems ambulances. Types: type I-conventional truck, cab-chassis with modular ambulance body, type I-AD (additional duty-with increased GVWR, storage, and payload capacity)-A or B or neonatal, critical patient transport, or A or B with rescue and fire suppression package, type II-standard van, integral cab-body ambulance, type III-cutaway van, cab-chassis with integral or containerized modular body ambulance, and type III-AD (additional duty-with increased GVWR, storage, and payload capacity) A or B or neonatal, critical patient transport, or A or B with rescue, or fire suppression package, or both. Performance test, vehicle weight test, road test, water spray test, and oxygen system test shall be performed to meet the requirements prescribed.1.1 This practice covers certified, tested, commercial type, EMSS ambulances built on chassis that are suitable for the intended application and meet the requirements herein. The ambulances are front or rear wheel driven (4x2) or four wheel driven (4x4) and warranted as specified in Section 9. 1.1.1 Definition of Ambulance—An ambulance is a vehicle for emergency medical care which provides: a driver's compartment; a patient compartment to accommodate an emergency medical technician (EMT)/paramedic and two litter patients (one patient located on the primary cot and a secondary patient on a folding litter located on the squad bench) so positioned that the primary patient can be given intensive life-support during transit; equipment and supplies for emergency care at the scene as well as during transport; two-way radio communication; and, when necessary, equipment for light rescue/extrication procedures. The ambulance shall be designed and constructed to afford safety, comfort, and avoid aggravation of the patient's injury or illness. 1.1.2 This practice may be used to procure an ambulance and the applicable additional systems and equipment. 1.1.3 Purchasers should follow the ordering data in 9.2 to aid them with the preparation of their procurement specification, requisition, and contract. The purpose of this practice is to describe minimum requirements for design, construction, performance, equipment, testing, and appearance of EMSS ambulances that are authorized to display the “Star of Life” symbol so as to provide a practical degree of standardization. The reasons for such standardization are to provide ambulances that are easily detected, nationally recognizable, properly constructed, easily maintained, and, when appropriately equipped, will enable Emergency Medical Technicians (EMTs) to safely and reliably perform their functions as basic and advanced prehospital life support providers as set forth in national EMSS standard training guidelines. These functions include: 1.1.3.1 Responding to, providing appropriate basic or advanced life support, on-site, to persons reported experiencing acute injury or illness in a pre-hospital setting, and transporting them, while continuing such life support care, to an appropriate medical facility for definitive care. 1.1.3.2 Providing interhospital critical transport care. 1.1.3.3 Transporting essential personnel and equipment to and from the site of a multiple medical emergency or a triage site and transporting appropriately triaged patients to designated medical facilities. 1.1.3.4 Other functions deemed appropriate by EMSS ambulance service managers and approved by designated EMSS medical directors. 1.2 “Star of Life” Certification—Ambulance manufacturer/contractor shall furnish the purchaser(s) citing this practice an authenticated certification and label (see 6.19) that certifies a “Star of Life” ambulance and equipment complying with this practice and applicable amendments (if any) in effect on the date of manufacture (see 7.3). Ambulance vehicles so certified may display the registered “Star of Life” symbol, as defined by the U.S. Department of Transportation (DOT) and the National Highway Traffic Safety Administration (NHTSA), see Fig. 1. 1.3 Classification—“Star of Life” ambulance designs included in this practice may be described in terms of their body type (I, II, or III), class of drive (“1” for two rear wheel drive or “2” for four wheel drive), and floor configuration (A for Advanced Life Support or B for Basic Life Support). Such descriptions may be used to define a variety of ambulance designs which are eligible for certification as “Star of Life” ambulances. (To specify, see 9.2.2 and 9.2.3). Note 1—For optional advanced life support (ALS) applications, users should consider specifying a modular (Type I or III) ambulance. Modular ambulances provide additional space and compartmentation for cardiac monitors, drug cases, and so forth. The basic life support (BLS) configuration is standard on all types. 1.3.1 Type I—Conventional truck, cab-chassis with modular ambulance body (see Fig. 2). Class Configuration Two rear wheel driven (4x2)A or B Four wheel driven (4x4)A or B Configuration A: Elevating cot and squad bench for ALS (see 6.1.5.1 and 6.11.4). Configuration B: Elevating cot and squad bench for BLS (see 6.1.5.2). 1.3.1.1 Type I—AD (Additional Duty—with increased GVWR, storage, and payload capacity)—A or B or Neonatal, Critical Patient Transport, or A or B with Rescue and Fire Suppression Package (see 6.1.2.1). Class Configuration Two rear wheel driven (4x2)A or B* Four wheel driven (4x4)A or B* *As specified by purchaser. The configuration shall provide for a neonatal, critical patient transport, configuration A or B with fire suppression package and rescue capability when specified. 1.3.2 Type II—Standard van, integral cab-body ambulance (see 6.1.3 and Fig. 3). Class Configuration Two rear wheel driven (4x2)A** or B Four wheel driven (4x4)*A** or B *Requires conversion of chassis to four wheel drive (4x4), (see 6.1.6). **On a Type II, ALS features are limited, (see 9.2.3). 1.3.3 Type III—Cutaway van, cab-chassis with integral or containerized modular body ambulance (see 6.1.4 and Fig. 4). Class Configuration Two rear wheel driven (4x2)A or B Four wheel driven (4x4)*A or B *Requires conversion of chassis to four wheel drive (4x4), (see 6.1.6). Configuration A: Elevating cot and squad bench for ALS (see 6.1.5.1 and 6.11.4). Configuration B: Elevating cot and squad bench for BLS (see 6.1.5.2). 1.3.3.1 Type III—AD (Additional Duty—with increased GVWR, storage, and payload capacity) A or B or neonatal, critical patient transport, or A or B with rescue, or fire suppression package, or both (see 6.1.4.1). ClassConfiguration Two rear driven (4 × 2)A or B* Four wheel driven (4 × 4)A or B* *As specified by purchaser. The configuration shall provide for a neonatal, critical patient transport, configuration A or B with fire suppression package and rescue capability when specified. 1.4 Order of Precedence—In the event of a conflict between the text of this practice and the references cited herein, the text of this practice shall take precedence, except where required by law including Federal, State, and local laws and regulations. 1.5 The values stated in SI units are to be regarded as the standard. The values given in parentheses are for information only. 1.6 This standard does not purport to address all of the safety concerns, if any, associated with its use. It is the responsibility of the user of this standard to establish appropriate safety and health practices and determine the applicability of regulatory limitations prior to use. FIG. 1 “Star of Life Symbol” FIG. 2 Type I Ambulance FIG. 3 Type II Ambulance FIG. 4 Type III Ambulance

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3.1 It is presumed for the purposes of this practice that the legal authority (agency) having responsibility for emergency services in a given jurisdiction also has a legal responsibility to provide workers’ compensation Insurance coverage for regular paid employees.3.2 Emergency services volunteers are presumed to be requested irregularly to provide special skills or assistance on behalf of the agency. As such, these volunteers act as part-time employees of the agency and are empowered to act to provide these services when specifically requested to do so, or pursuant to an approved plan or schedule, or under the supervision of a full-time employee.3.3 The legal authority incurs workers’ compensation insurance responsibility for emergency services volunteers (ESVs) while the ESV is actively providing services to the agency as defined in Section 5 of this practice. This period of activity shall be considered to be employment as defined by the state workers’ compensation statutes of the agency.3.4 When a legal authority (agency) requests the services of emergency services volunteers as defined by this practice to provide services, the agency shall assume responsibility for the injuries, medical treatment, loss of wages, and death of those emergency services volunteers while providing services as described in this practice.3.5 Responsibility for the injuries, medical treatment, loss of wages, and death of those emergency services volunteers while providing services as described in this practice shall be at the statutory limits of the workers’ compensation laws of the state of the agency requesting the services of the emergency services volunteer, and shall be administered in accordance with that agency's state workers’ compensation laws and regulations.3.6 Responsibility for workers’ compensation for members of emergency services units shall be the same as outlined in 3.1, and shall be provided by the agency normally directing the activities of the ESU.3.7 Responsibility for workers’ compensation for members of emergency services auxiliary units shall be the same as outlined in 3.1, and, unless provided for by other statute or agreement, shall be provided by the agency requesting the services and directing the activities of the AU.3.8 To provide an agency with trained personnel who are able to work in a safe and effective manner, it is generally required that the emergency service volunteer engage in training activity with the emergency service unit.3.8.1 A training plan is considered essential in establishing the basis for workers’ compensation insurance coverage during training. The plan serves as both prior notice to the responsible legal authority and documentation of training done to support the level of service provided. The training plan is considered to be a dynamic document, reflecting necessary changes due to weather, unit participation, newly identified skills, and rearranged priorities. As changes are made to the training plan, the revised plan is to be submitted to the agency.3.8.2 The training plan may be required by the agency, municipality, or government entity providing coverage and benefits in accordance with its contract for services or merely as a convenience to define activity periods.3.8.3 The training plan should establish goals and list measurable objectives. These goals provide a basis for a relationship between training and the incident response services provided. The plan should list all planned activity of the unit and who is expected to participate. This will delineate where insurance coverage is needed and expected. The plan should detail what supervision of activities and resources of the legal authority is expected. The plan should establish a means of accountability to the responsible legal authority for the unit's training activities, such as by check-in with a central dispatch, and listing on a formal activity roster.3.8.4 The training plan will contain the following elements to qualify for inclusion in workers’ compensation coverage:3.8.4.1 Identification of the emergency services unit.3.8.4.2 Definition of the period of time covered by the plan, usually a year.3.8.4.3 Establishment of the relationship of the ESU with the legal authority.3.8.4.4 Establishment of the overall plan goals.3.8.4.5 Broad outline of training plan (that is, field and classroom, equipment maintenance, training outside of the jurisdiction of the agency, and so forth).3.8.4.6 Specific outline of training plan (such as rappelling, nighttime field navigation, search and fire fighting techniques, medical applications, and so forth).3.8.4.7 Establishment of criteria for objective satisfaction.3.8.5 This training plan and activity must address techniques, skills and safety, and must be designed to enable the individual and the unit to meet recognized national standards or other standards as acceptable to the requesting agency.3.8.6 It is recognized that training for hazardous activity is often hazardous in and of itself, by the nature of the skills that the ESV is required to master.3.8.7 Since the agency is the beneficiary of this training, the ESV is said to be employed by the agency for the purposes of workers’ compensation benefits while engaging in training as a member of an emergency services unit. Covered training activities are those activities defined as official activities in a memorandum of understanding or other agreement between the ESU and the agency, where the agency is providing workers’ compensation benefits.3.9 An emergency services volunteer or unit may be requested by an agency to provide public education services. These services may include public appearances, preventative search and rescue (PSAR) programs, air search familiarization for ground search operations, first aid and CPR education, fire prevention education, and others.3.9.1 When engaged in such activities authorized by the agency, the ESV or ESU is considered to be employed by the agency for the purposes of workers’ compensation insurance.1.1 This practice defines the application of insurance benefits for emergency services volunteers and units in the manner and extent as provided for under the workers’ compensation statutes of the state in which the volunteer or unit provides services.1.2 This practice identifies the basic types of emergency service volunteer, and the types of activities that should be covered by workers’ compensation insurance.1.3 This practice includes both emergency service units who operate as organized resources to a public authority legally responsible for the provision of search and rescue and other emergency services, as well as those volunteers who respond to a general request to the public for their services.1.4 This standard does not purport to address all of the safety concerns, if any, associated with its use. It is the responsibility of the user of this standard to establish appropriate safety, health, and environmental practices and determine the applicability of regulatory limitations prior to use.1.5 This international standard was developed in accordance with internationally recognized principles on standardization established in the Decision on Principles for the Development of International Standards, Guides and Recommendations issued by the World Trade Organization Technical Barriers to Trade (TBT) Committee.

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4.1 Implementation of this practice will ensure that the EMS system has the authority commensurate with the responsibility to ensure adequate medical direction of all pre-hospital providers, as well as personnel and facilities that meet minimum criteria to implement medical direction of pre-hospital services.4.1.1 The state will develop, recommend, and encourage use of a plan that would ensure the standards outlined in this document can be implemented as appropriate at the local, regional, or state level (see Guide F1086).4.1.2 This practice is intended to describe and define responsibility for medical directions during transfers. It is not intended to determine the medical or legal, or both, appropriateness of transfers under the Consolidated Omnibus Budget Reconciliation Act and other similar federal or state laws, or both.1.1 This practice covers the qualifications, responsibilities, and authority of individuals and institutions providing medical direction of emergency medical services.1.2 This practice addresses the qualifications, authority, and responsibility of a Medical Director (off-line) and the relationship of the EMS (Emergency Medical Services) provider to this individual.1.3 This practice also addresses components of on-line medical direction (direct medical control) including the qualifications and responsibilities of on-line medical physicians and the relationship of the pre-hospital provider to on-line medical direction.1.4 This practice addresses the relationship of the on-line medical physician to the off-line Medical Director.1.5 The authority for control of medical services at the scene of a medical emergency is addressed in this practice.1.6 The requirements for a Communication Resource are also addressed within this practice.1.7 This international standard was developed in accordance with internationally recognized principles on standardization established in the Decision on Principles for the Development of International Standards, Guides and Recommendations issued by the World Trade Organization Technical Barriers to Trade (TBT) Committee.

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This Standard specifies the Services and Event Reports for Computer-Supported Telecommunications Applications, Phase III (CSTA).

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This specification covers spring-loaded, angle style, pressure relief valves for steam, gas, and liquid system applications. Pressure relief valves shall be of the following types and material grades: Type I, Grades A and B; Type II, Grades C and D; and Type III, Grades E and F. Hydrostatic shell test and set pressure, blowdown, and seat tightness test shall be performed to meet the specified requirements.1.1 This specification covers spring-loaded, angle style, pressure relief valves for steam, gas, and liquid system applications (excluding boiler safety and hydraulic system relief valves).1.2 The values stated in inch-pound units are to be regarded as standard. No other units of measurement are included in this standard.1.3 This international standard was developed in accordance with internationally recognized principles on standardization established in the Decision on Principles for the Development of International Standards, Guides and Recommendations issued by the World Trade Organization Technical Barriers to Trade (TBT) Committee.

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4.1 This guide provides minimum guidelines for safe and efficient ambulance operation.4.2 All ambulance operations and operators should follow this guide for the development of educational and training programs.4.3 This guide is intended to promote safe and efficient ambulance operations and to reduce morbidity, mortality, and property loss associated with ambulance operations.4.4 This guide is intended to assist those who are responsible for the development and implementation of policies and procedures for ambulance operations.1.1 This guide covers minimum standards for the performance of emergency medical services (EMS) ambulance operators, including: operator qualifications, pre-run operation, and post-run aspects.1.2 This guide shall promote the safe and efficient delivery of the ambulance, equipment, crew, passengers and patients, during all phases of the delivery of EMS involving the ambulance; at all times exercising the highest degree of care for the safety of the public. This guide may be applied to other EMS vehicles that do not necessarily provide patient transport.1.3 This guide shall be used as the basis for training guides of the emergency medical services ambulance operator.1.4 The values stated in inch-pound units are to be regarded as standard. The values given in parentheses are mathematical conversions to SI units that are provided for information only and are not considered standard.1.5 This standard does not purport to address all of the safety concerns, if any, associated with its use. It is the responsibility of the user of this standard to establish appropriate safety and health practices and determine the applicability of regulatory limitations prior to use.

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5.1 In situations in which the coordination of EMSS communications among political subdivisions affects the health and safety of the state’s population, it is appropriate for state government to take a coordinating role. Statewide planning for coordinated use of radio frequencies for EMSS communications is specifically needed.5.2 The state is the logical unit to formulate the statutory and regulatory framework for EMSS planning. State planning for area-wide EMSS communications provides authority to accomplish coordination in the use of available radio frequencies, thus promoting multiagency cooperation to best serve the public needs.5.3 With statewide planning, communities, counties, and multicounty EMSS regions are provided with guidance to achieve the performance goals and objectives of their EMSS communications systems.5.4 The statewide EMSS communications performance goals and objectives in Sections 10 – 15 address specific roles of state governments in EMSS communications systems planning. These performance goals and objectives should be considered by states for evaluating, planning, and implementing of acceptable EMSS communications statewide.1.1 This guide covers telecommunications practices and performance standards required to support all of the functions of community EMSS on a statewide basis. It defines state planning goals and objectives for EMSS communications.1.2 This guide is for planning, coordinating, integrating, and evaluating telecommunications resources statewide to satisfy the functional needs of comprehensive community EMSS systems.1.3 To facilitate a two-tiered planning approach recommended for EMSS communications, this guide identifies those communications system features that should be coordinated on a statewide basis and defined in statewide (first tier) EMSS communications planning guidelines. Local (second tier) EMSS communications plans prepared in accordance with the statewide guidelines should then be tailored to satisfy local EMSS needs while providing compatibility and interoperability of communications with other EMSS.1.4 The sections in this guide appear in the following sequence:  Section  1Referenced Documents 2Terminology 3Summary of Guide 4 5Functions and Categories of EMSS Communications 6 Telecommunications Functions 6.1 Telecommunications Categories 6.2EMSS Functional Communications Requirements 7 General Information 7.1 Citizen Access 7.2 EMSS Vehicle Dispatch and Coordination 7.3 Medical Coordination/Direction 7.4 Interservice Communications 7.5Radio Frequency Spectrum and Service Requirements 8 Radio Frequencies 8.1 EMSS Radio Service Coverage 8.2 Operational Considerations 8.3Goals and Objectives for EMSS Communications 9Goal 1—State EMSS Communication Should Meet Recognized Standards for Functional Performance 10Goal 2—Local EMSS Communications Should Be Compatible with, and Should Not Interfere with, EMSS Communications in Neighboring Area 11Goal 3—Local EMSS Communications Systems Should Be Compatible with, and Should Not Interfere with, Other Types of Communications Systems 12Goal 4—EMSS Communications Systems Should Make Maximum Use of State and Common Resources Where Appropriate, Cost Effective, and Authorized 13Goal 5—The State Should Act as the Representative of Local EMSS in Dealing with Federal Agencies and National Organizations 14Goal 6—The State Should Have a Program for Positive Management of Its EMSS Communications Activities 15Emergency Medical Radio Services (EMRS) Radio Frequencies (MHz) Appendix X1Acronyms and Glossary for EMSS Communications Appendix X2References  1.5 This standard does not purport to address all of the safety concerns, if any, associated with its use. It is the responsibility of the user of this standard to establish appropriate safety, health, and environmental practices and determine the applicability of regulatory limitations prior to use.1.6 This international standard was developed in accordance with internationally recognized principles on standardization established in the Decision on Principles for the Development of International Standards, Guides and Recommendations issued by the World Trade Organization Technical Barriers to Trade (TBT) Committee.

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1.1 This guide covers providing system evaluation for emergency medical services (1), including authority, responsibility, objectives, approaches, data, applications, and implementation.Note 1—This guide does not address evaluation for individual prehospital, hospital, or posthospital providers. (Related guides will be developed.)

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4.1 Since the quality of EMT training depends, in large measure, on the instructional abilities and competencies of the EMT instructor, it is imperative that the individual selected and used in this capacity possess the qualifications and capabilities necessary to provide effective instruction.4.2 An EMT instructor must possess clearly defined knowledge and skills competencies, have clearly defined responsibilities and scope of authority related to instructional programs, and meet other specific requirements pertinent to the level of instruction.4.3 Using this guide, EMS institutions and organizations should be able to develop requirements for selection and utilization of EMT instructors for EMT training and education programs.1.1 This guide is intended to assist emergency medical services (EMS) agencies and institutions in selecting and utilizing individuals who teach in EMT (emergency medical technician) training programs which include instruction in basic life support knowledge and skills.1.2 This guide identifies six categories of instructor in an EMT (emergency medical technician) training program: adjunct instructor, clinical/field preceptor, practical skills instructor, associate instructor, course instructor/coordinator (I/C), and course administrator. The guide recognizes that an individual may, depending on his/her level of practice and the training program involved, function in any or all of these categories.1.3 This guide includes specific guidelines for qualifications, training, education, experience, scope of authority, responsibilities, continuing education, evaluation, and maintenance of competency when applicable.1.4 This guide does not include specific guidelines for the course administrator or the adjunct instructor. While the guide recognizes, by offering a definition of each category, that these types of individuals function in many EMT training programs, the limited instructional roles played by these individuals preclude the need for specific selection and utilization guidelines.1.5 This guide is intended to apply to any individual who teaches in EMT training programs regardless of the individual's present level of clinical practice.1.6 This guide intentionally omits references to length of pre-hospital care experience, teaching experience, and continuing education requirements. This guide also omits reference to waiver or equivalency. These issues should be addressed by the appropriate agency.1.7 This guide applies only to instructors who teach in basic life support training courses designed to prepare an individual for certification to practice above the level EMT. It does not apply to instructors who teach in specialized courses that do not in themselves qualify the individual for a level of EMT certification.1.8 This guide does not establish certification requirements. Such requirements should be established by the certifying agency in the jurisdiction in which the EMT instructor will function. This guide may be used to provide considerable guidance to the jurisdiction responsible for establishing certification standards.1.9 This standard does not purport to address all of the safety concerns, if any, associated with its use. It is the responsibility of the user of this standard to establish appropriate safety, health, and environmental practices and determine the applicability of regulatory limitations prior to use.NOTE 1: Also see Practice F1031.1.10 This international standard was developed in accordance with internationally recognized principles on standardization established in the Decision on Principles for the Development of International Standards, Guides and Recommendations issued by the World Trade Organization Technical Barriers to Trade (TBT) Committee.

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